EMPLOYMENT CERTIFICATION FORM (VA Form 22-10201)

Forms and Documents

Document Name	Status
Form VA Form 22-10201 Employment Certification Form Form	Modified
Non Material Non Substatial Revision Request for Revision of VET TEC EMPLOYMENT CERTIFICATION FORM (002) 05052021.docx Justification for No Material/Nonsubstantive Change	2021-05-05
Participation Agreement Payment Clause.pdf Supplementary Document	2019-12-18
30-Day FRN - 2900-New (VA Form 22-10201) 2019.pdf Supplementary Document	2019-06-11
VET TEC Employment Verification Form SupportingStatement.docx Supporting Statement A	2019-06-12
60-Day FRN - 2900-NEW (VA Form 22-10201) 2019.pdf Supplementary Document	2019-04-18

IC Document Collections

IC ID	Document Title	Status
235408	Employment Certification Form Form	Modified

ICR Details

OMB Control No: 2900-0874	ICR Reference No: 202105-2900-002
Status: Received in OIRA	Previous ICR Reference No: 201903-2900-023
Agency/Subagency: VA	Agency Tracking No: VBA-EDU-NK
Title: EMPLOYMENT CERTIFICATION FORM (VA Form 22-10201)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/06/2021

	Requested	Previously Approved
Expiration Date	12/31/2022	12/31/2022
Responses	562,500	562,500
Time Burden (Hours)	46,875	46,875
Cost Burden (Dollars)	0	0

---

Abstract: On August 16, 2017, the President signed into law the Harry W. Colmery Veterans Educational Assistance Act of 2017(“Forever GI Bill”), Public Law 115-48, which amends Title 38, United States Code to make certain improvements in the laws administered by the Secretary of Veterans Affairs (VA), and for other purposes. Section 116 of the law authorizes VA to establish a 5-year high technology pilot program for veterans as an educational program provided by leading technology employers. Section 116 also requires that VA receive employment certification from school certifying officials (SCOs) and veterans enrolled in the VET TEC pilot program.

---

Authorizing Statute(s): PL: Pub.L. 115 - 48 116 Name of Law: Harry W. Colmery Veterans Educational Assistance Act of 2017
  

Citations for New Statutory Requirements: PL: Pub.L. 115 - 48 116 Name of Law: Harry W. Colmery Veterans Educational Assistance Act of 2017

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 12670	04/02/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 26938	06/10/2019
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Employment Certification Form	VA Form 22-10201	Employment Certification Form

---

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	562,500	562,500	0	0	0	0
Annual Time Burden (Hours)	46,875	46,875	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $3,422,813

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/06/2021

---